Global Surgery`s different universes

I had the honour, the privilege, the time, the money and the right passport to go to Geneva to attend meetings and events by leading global surgery organizations like the G4Alliance during the World Health Assembly this May.

I have lived in Switzerland for 10 years but had never made it to Geneva for more than a few hours. 

It all started with a visit of a chair person of the board of the G4Alliance at KCMC, that convinced me of the usefulness of attending these meetings around the WHA in person. I was excited and thrilled to be able to be a part of the world politics and diplomatics discussing issues that matter deeply to me. Isn`t Geneva the place to talk and to act upon the inequity that exists in this world!?

Just before the week was about to start I read a post on Linkedin written by an ethiopian colleague of mine working for Smile Train. His visa application for Switzerland had been rejected after the interview because of „reasonable doubt“, he had been fully funded by his organization to attend the World Health Assembly events to advocate for neglected surgical conditions in children in fact to advocate for african patients that are neglected by the world. But without i.e. an invitation from a swiss citizen he would not be able to set a foot on swiss soil... which hypocratic (global health) world are we living in? The WHO has its headquarters in one of the richest country of the world – but instead of welcoming people from all over the world to participate in decisions that matter most of all to them – they are refused entry.

I vote for strong african institutions – African Union, African Health Organization, African CDC – let the headquarters be in Africa and let the World Health Assembly be facilitated in a true democratic manner for everyone from everywhere.

So I went to Geneva, as a german citizen I didn`t need a visa, of course. Geneva is a nice french/swiss cultured middle sized city beautifully nudged into the most western edge of Lac Leman with the Mont Blanc and its white mountain range glancing in the background. I had forgotten how beautiful the month of May can be – summer is in the air, on the lakesides in Switzerland its warm and sun shines until late in the evening. While May is an off season in the mountains its the perfect time to welcome the world when everything is blossoming in the low lands, the air is crisp in the morning and it gets already really warm during day time. I enjoyed every minute of it!

The meetings of the G4Alliance were very inspiring. So many like minded people with diverse backgrounds working and advocating for safe, timely and affordable surgical, obstetric, trauma and anaesthesia (SOTA) care for everyone everywhere. SOTA – care is the acronym for what global surgery also stands for. Its the field of practice, education and research of improving access to timely, quality and affordable SOTA care. It emphasizes horizontal health systems strengthening for improved care particularly of vulnerable populations.

I was delighted to be able to meet so many people especially from the US where most of the programmes for global surgery have been created. It is truely special to meet the heroes of a discipline you have been working in for a few years, reading their papers, following their actions and finally you feel being part of the same movement.

As expected my fellow participants, the audience, facilitators and speaker were mainly from high income countries. But two strong female leaders from Africa stood out. One was Professor Salome Maswime from Cape Town which I knew personally from the wonderful leadership course I attended in February this year. She was speaking with a clear voice for the million of women suffering the lack of safe, timely and affordabe obstetric care in their countries. And Professor Hadiza Shehu Galadanci from Nigeria was the second impressive inspiring african woman – scientist – clinician – advocat talking about her practice as a gynecologist in Nigeria, where she is not able to serve her patients with basic treatment for early and late stage of cervica cancer. Cervical cancer has been shown to be completely preventable with the HPV vaccines that had been invented around 25 years ago – I got my vaccines when I was 16, of course.

There were at least a handful more people that were very inspiring to me – just to name Dr John Meara who held a very interesting and pictured talk about the evolution of global surgery and Dr Kennedy Lishimpi health secretary of Zambia who described the implementation of screening for cervical cancer and enrolment of vaccination protocols in Zambia.

As usual the time was scarce and meeting everyone impossible.

What I took from these 6 days in Geneva in a few sentences:

• Collaborate more inside the countries!

• Think Big and make small things happen at a time. ..the low hanging fruit was also mentioned often ;)

• Advocacy is key even if its not or only diffcult to measure.

• Data is knowledge and knowledge is key for improvement.

• The WHO does have NO money.

• The SurgFund is not comparable to the Global Fund as this was an initiative of the US government.

• Climate change is affecting health care and health care is affecting climate change.

• Implementation science is the new deal (at least for me).

• FGM and obstetric fistula are symptoms of the same disease: women are not valued enough!

• There is not enough O in the room – the Global surgery discussion needs to reach the obstetricians.

  
  

• The biggest investment needs to go into leadership.

• Surgery is the corner stone of health care!